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It is rare that I walk into a patient room in my office when not one or more people are on some sort of device. This includes parents, grandparents, siblings, and patients as young as 18 months. Some put down their screens as soon as I walk in. Most do not. When I’m examining a patient who becomes fussy, a parent will often fumble for a phone, search to find a pleasant video, and expect this to somehow soothe an already writhing child as I try to look in their ear or check their throat. This never works. Never. They are already upset, unable to be soothed by “Frozen,” “Peppa Pig,” or “Minecraft.” Put the phone down and let’s get this over with, shall we?

Despite recent American Academy of Pediatrics guidelines that there should be no screen time at all for toddlers, the vast majority now have regular exposure. This, in part, is due to parental use, sibling use, and the semblance that some learning is going on from ABC’s flashed on a screen. A recent study, however, demonstrated that handheld screen time can be associated with expressive language delays in children. The authors discuss that this was not a hard and fast rule, but that increased amount of daily screen time correlated with slower language progression. As more forms of screens become available, there are more ways to assess their benefits, and, more often, risks. Despite continued negative findings, dating back to evidence that “Baby Einstein” videos did not produce Baby Einsteins, access and use only continues to rise.

I’ll be the first to be down on too much screen time for young kids. Our at-home restrictions have led our kids to declare us to be some of the most evil parents on the planet, but so be it. There is, however, a screen time nirvana which is often overlooked: the preoperative unit. Surgery in children is never something one would desire. It is every parent’s worst fear, and every child’s worst nightmare. Pediatric specialists have spent entire careers trying to mitigate the anxiety and stress that goes along with a child about to undergo surgery. Pre-medicating children with a sedative similar to valium has been a mainstay. However, it is a strong medication that carries risks of over-sedation, nausea, and slowed wake-ups after surgery. Parental presence, meaning a parent comes into the operating room until the child is asleep. has more recently become the mainstay, as most children fear separation more than anything. But with it comes parental tears, and even the occasional fainting in front of the child. Often the operative team ends up soothing the parent more than we or the parent soothe the child. This helps nobody.

And then there are the screens. I’ll never forget the first week the iPad came out. A child had it in the preoperative area, calmly pushing his finger across the screen to bake fake cookies. He was calm. So was his mom. And as the handheld device technology progressed, so did interest in how this may impact children during some of the most stressful situations on the family– coming for surgery. The studies that followed were fascinating. Not only did children have less anxiety going in to surgery, they had less postoperative anxiety as well. In fact, using a handheld device actively (playing a game or creating something) is more effective than passively watching, as it gives a child a sense of control over a given event. This sense of control, combined with the distraction of the non-medically related task of playing a game on a screen is a major source of anxiety relief. And here’s the kicker: such a task is better than valium in reducing anxiety. That’s right, what so many of us dread is actually true, but this time it’s a good thing: your kid’s iPad is better than a drug. And to kick it more: it’s better at reducing anxiety than presence of a parent. Something dreaded when casually mentioning that your kid’s iPad is the new babysitter– in some situations, it’s better than a parent. And who said humans are being replaced?